Chiropractic insurance billing in Indiana.

Original Medicare Part B covers medically necessary manual spinal manipulation to correct a subluxation (CPT 98940 to 98942). Use the AT modifier for active or corrective treatment; the modifier alone does not establish medical necessity.

For a usually covered service expected to be denied in a particular case, such as spinal manipulation that has become maintenance care, a valid ABN is required before treatment to transfer potential financial liability to the patient. Exams, X-rays and therapies performed by a chiropractor are statutorily excluded from this benefit; an ABN for those services is voluntary. Medicare Advantage uses separate plan coverage and notice procedures, not the Original Medicare ABN. See CMS guidance on advance notices and our chiropractic Medicare billing guide.

Original Medicare Part B claims in Indiana are processed by WPS Government Health Administrators (J8). Check its applicable Local Coverage Determination and documentation requirements for the date of service.

Carriers listed for Indiana include Anthem Blue Cross Blue Shield (Elevance Health); UnitedHealthcare; Centene (Ambetter / managed Medicaid); CareSource; Aetna; Cigna. Check the member’s product, network, claim destination and applicable chiropractic policy.

Chiropractic benefits can be administered by the health plan or a delegated specialty network such as American Specialty Health (ASH) or Optum. Confirm network participation, any treatment-plan review, and the claim destination separately for the member’s product.

An authorization delegated to a vendor does not by itself mean the claim is sent to that vendor. ASH requirements follow the applicable Client Summary and provider agreement. For services on or after October 1, 2026, UnitedHealthcare’s Medicare Advantage reduction table removes prior authorization for 98940-98942, subject to product-specific exceptions.

These codes do not appear in the separate D-SNP reduction table. Check the member’s product and billed code; commercial and other therapy requirements are separate.

What trips up chiropractic billing in Indiana:

• INDIANA CHIROPRACTIC EQUAL-REIMBURSEMENT STATUTE — IC 27-8-6-1 provides that if an accident-and-sickness policy reimburses a service within the lawful scope of a duly licensed Indiana chiropractor, the insured is entitled to reimbursement on an EQUAL basis whether the service is performed by a physician or by a licensed chiropractor (a non-discrimination mandate). It does NOT force coverage of a service the plan doesn’t otherwise cover, set rates, or override Medicare/Medicaid program rules. IC 25-1-9-6.5 provides discipline when a chiropractor both waives required deductibles/copays and advertises that waiver. Its exception requires an individual finding of immediate health need and substantial financial hardship; it is not a regular business practice.
• IHCP covers medically necessary chiropractic services under approved codes and diagnoses. Its fee-for-service rules allow 50 units per calendar year across office visits, manipulation and physical medicine, including up to five office visits; medically necessary additional treatments require prior authorization. Hoosier Healthwise Package C instead allows five visits and 14 physical-medicine treatments, with up to 36 additional treatments after approval. Certain covered related services are outside the 50-unit pool. HIP Basic excludes chiropractic manipulation; HIP State Plan Basic and other benefit packages have different coverage. Managed-care plans apply their own covered-service and authorization instructions.
• Original Medicare Part B covers medically necessary manual spinal manipulation to correct subluxation (98940-98942); use AT for active/corrective care. Maintenance care is not covered: a valid ABN before expected medical-necessity denial is required to transfer liability, with GA or GZ as appropriate. Exams, X-rays and therapies furnished by a chiropractor are statutorily excluded; an ABN for excluded services is voluntary and GY identifies the exclusion. Medicare Advantage may offer supplemental benefits and uses its own coverage, authorization and notice procedures, rather than the Original Medicare ABN.
• Commercial benefits — use the member’s benefit document and current clinical policy for covered codes, shared therapy allowances, treatment plans and review. Check the covered-service allowance and review requirement for the member’s product. Same-day distinct services must be documented and coded under the applicable payer policy.
• For services on or after October 1, 2026, UnitedHealthcare’s Medicare Advantage reduction table removes prior authorization for 98940-98942, subject to product-specific exceptions. These codes do not appear in the separate D-SNP reduction table. Check the member’s product and billed code; commercial and other therapy requirements are separate. Confirm clinical-review routing separately from the claim destination.
• WORKERS’ COMP — treatment is employer/carrier-directed (the employer selects the treating physician in Indiana); chiropractors must bill within 120 days (631 IAC 1-1-32), reimbursement follows the pecuniary-liability/80th-percentile framework, and disputes run through the Worker’s Compensation Board billing-review process.
• MVA — since Indiana has no PIP, chiropractic MVA care is paid by optional MedPay (up to limits), the patient’s health plan, or on a third-party lien / letter-of-protection basis at settlement, with the 2-year personal-injury SOL (IC 34-11-2-4) bounding the underlying claim. Not legal advice — verify benefits and current rules per payer.

Largely contract/payer-set, NOT fixed by an Indiana statute. Indiana context: the state’s prompt-pay law — IC 27-8-5.7 (Accident and Sickness Insurance; Provider Payment) — governs how fast the INSURER must adjudicate a CLEAN claim: an insurer shall pay or deny each clean claim within thirty (30) days if filed electronically or forty-five (45) days if filed on paper, with interest accruing thereafter (beginning the 31st day electronic / 46th day paper) per IC 27-8-5.7-6; it does NOT set the provider’s SUBMISSION deadline, which remains contractual.

Note: a fully-insured commercial plan governed by Indiana law differs from a self-funded ERISA plan (where federal law and the plan document control) — verify which applies.

Original Medicare fee-for-service claims generally must be received within 12 months of service, with limited CMS exceptions. WPS Government Health Administrators (J8) processes the state's Part A/B claims. Medicare Advantage filing periods follow the member plan and provider agreement.

Original Medicare's chiropractic benefit is medically necessary manual spinal manipulation to correct subluxation; Medicare Advantage may offer additional covered services.

Indiana Medicaid (Indiana Health Coverage Programs / IHCP) is a 180-DAY state: initial fee-for-service provider claims for services rendered must be ORIGINALLY FILED within one hundred eighty (180) days of the date of service (or date of discharge for inpatient), per 405 IAC 1-1-3 (this 180-day window took effect for dates of service on or after January 1, 2019; before that it was 12 months).

The limit may be EXTENDED in defined circumstances under 405 IAC 1-1-3 — e.g., retroactive member eligibility (one year from the date eligibility was entered into Core MMIS), retroactive provider enrollment (180 days from approval), office error/action delaying payment, reasonable continuous attempts to resolve a claim problem or to first bill a third-party-liability source, and Medicare/Medicaid crossover failures.

The IHCP managed-care entities (the MCEs/MCOs — Anthem, MHS/Managed Health Services, CareSource, UnitedHealthcare Community Plan, administering Hoosier Healthwise, HIP, and Hoosier Care Connect) set their own initial-claim, correction and appeal timeframes — confirm each plan’s exact rule.

Medicaid is the payer of last resort. MDwise ceased participating as an IHCP MCE on January 1, 2026; identify the member’s current MCE rather than routing claims under its former participation.

Indiana’s medical-provider rule calls for bills within 120 days of service. The Board’s pecuniary-liability guidance says that an otherwise authorized bill should not be denied solely for missing that rule. Current clean-claim payment requirements under IC 22-3-7.2 are 30 days after electronic receipt or 45 days after paper receipt; overdue clean claims carry the applicable annual interest rate, 4% for 2026.

Individual professional/chiropractic reimbursement uses pecuniary liability and the 80th-percentile framework; medical facilities have separate Medicare-based limits. A provider requesting Board review uses SF 18487 and must serve the payer itself.

Indiana’s optional Medical Payments coverage pays eligible medical bills under the actual policy limit and terms. Submit under its notice and proof-of-loss conditions, and protect the health plan’s separate filing deadline while a liability claim is pending.

Third-party bodily-injury settlement timing is distinct from first-party MedPay and from provider filing. Indiana’s personal-injury limitation is generally two years, with applicable exceptions.